Seventh National Conference on Quality Health Care for Culturally Diverse Populations: Main Conference Oral Presentations (concurrent workshops and peer-to-peers) Linguistic Access Services in the United States: Do They Measure Up to the National Culturally and Linguistically Appropriate Services Standards?

B-1 Setting standards for Culturally and Linguistically Appropriate Care: Models and lessons from the US and abroad

Linguistic Access Services in the United States: Do They Measure Up to the National Culturally and Linguistically Appropriate Services Standards?
Tuesday, October 19, 2010: 1:45 PM-3:45 PM, RHP, Baltimore Salon A
Federal regulations require health care organizations to provide language services for limited English proficiency (LEP) patients. The National Standards on Culturally and Linguistically Appropriate Services (CLAS standards) in Health Care, issued by the Office of Minority Health, include 4 that outline what it means to provide adequate linguistic access services to LEP patients as proscribed in Title VI of the Civil Rights Act. It is not known how US hospitals have incorporated the CLAS standards into practice.
We sampled 239 hospitals using 2 different methods: a directed and a national sample. Both samples were generated as a part of the Hospitals, Language, and Culture Study (HLC), recently conducted by The Joint Commission. We received survey responses from 135/221 (61%). We used standard frequency analyses to describe the study sample and their responses. We conducted bivariate analyses using the χ2 or Fishers Exact test, where appropriate, to assess differences between responders and nonresponders and between the directed and national sample subgroups.
Seventy-eight percent of hospitals were able to provide interpreters for their most common language within 15 minutes during business hours, but only 48% could provide interpreters in that time frame for their third most common language. Hospitals were more challenged to inform patients of their right to linguistically accessible services. Less than 50% did so via Patients’ Bill of Rights forms and posters in other languages and in English (48% and 44%), forms or brochures in other languages and in English (40% and 29%), multilingual posters (32%), verbally in other languages (33%), through interpreter services outreach (4%) and media campaigns (2%).  Most hospitals did not meet the standard regarding use of competent interpreters either: 62% reported that family members or friends of patients were used as interpreters, even though 70% of these hospitals also reported having a policy prohibiting this practice. Most hospitals required that staff (79%) and contract (63%) interpreters undergo interpreter training, but ad-hoc interpreters, such as volunteers and bilingual staff usually did not. Finally, hospitals made the following translated documents available in their most commonly requested language: Advance directives (65%), patients’ rights (61%), discharge instructions (58%), informed consent (57%) and hospital signage (51%). Less than a third of hospitals had these written documents available in two or more non-English languages. Very few hospitals could provide all of these forms in their most common language (17%).
Our study documents that many hospitals are not providing language access services as required by federal law, even those that are held up as example institutions. Enforcement of Title VI is difficult and infrequent and the threat of enforcement is not a big enough concern to motivate hospitals. Hospitals will likely be moved into greater compliance due to efforts by The Joint Commission, the National Quality Forum, and the National Committee for Quality Assurance, all of which are using the CLAS standards to develop standards for linguistically accessible care. Our study reinforces the importance of these efforts and helps target interventions to improve the delivery and safety of care to LEP patients.
  • Lisa Diamond Diversity Rx slides.pdf (136.5 kB)
  • Presentations
  • Lisa Diamond Diversity Rx slides.pps (1.6 MB)
  • Presentation Information:

    Program: Main Conference Oral Presentations (concurrent workshops and peer-to-peers)
    Primary Category: Organizational Cultural Competence
    Subtopics: Federal, Implementing the CLAS standards or other cultural competence frameworks, Observational/descriptive studies

    Region Addressed by Presentation: National
    Organization: Hospital

    Lisa Diamond, MD, MPH , Health Policy Research, Palo Alto Medical Foundation Research Institute, Palo Alto, CA
      Palo Alto Medical Foundation Research Institute
      Health Policy Research
      795 El Camino Real, Ames Building
      Palo Alto CA, USA 94301

      Phone: 650-853-3383
      Email Address:

      Biographical Sketch:
      Lisa Diamond, MD, MPH, is a Research Physician and Hospitalist. Her research focuses on understanding how clinician non-English language proficiency influences the quality of care delivered to patients with limited English proficiency (LEP). Ultimately, she plans to use the results of her research to establish standards for the appropriate use of non-fluent non-English language skills by clinicians and to identify process measures that capture the quality of care being delivered to LEP patients. Prior to joining Palo Alto Medical Foundation Research Institute, Dr. Diamond completed her Internal Medicine residency at New York Presbyterian/Columbia University Medical Center, followed by a fellowship in the Robert Wood Johnson Clinical Scholars Program at Yale University.

    Amy Wilson-Stronks , Division of Research, The Joint Commission, Oakbrook Terrace, IL
      The Joint Commission
      Division of Research
      Oakbrook Terrace IL, USA

    Elizabeth Jacobs, MD, MPP , Division of General Medicine & Primary Care, Stroger Hospital of Cook County & Rush University Medical Center, Chicago, IL
      Associate Professor of Medicine
      Stroger Hospital of Cook County & Rush University Medical Center
      Division of General Medicine & Primary Care
      1900 W Polk Street , 16th floor
      Chicago IL, USA 60612

      Phone: 312-864-7311
      Email Address:

      Biographical Sketch:
      Elizabeth A. Jacobs, MD MAPP. Dr. Jacobs is a Clinician-researcher and Associate Professor of Medicine at The John H. Stroger, Jr. Hospital of Cook County and Rush University Medical Center. She attended medical school at University of California at San Francisco, trained as a general internist at Brigham and Women’s Hospital in Boston, and completed a Robert Wood Johnson Clinical Scholars Fellowship at the University of Chicago. After struggling to care for limited English-speaking patients during medical school and residency, she decided to pursue a research career investigating minority disparities in health care. She has an extensive record of research funding and academic publications and is recognized as an expert on the provision of linguistically accessible and culturally competent care